Trade Flows in Medical Goods and Services
Box 1.1 Access to health care: The role of (trade in) health insurance services (Continued ) may contribute to the uptake of private health insurance by bringing capital, technology, and know-how. In that regard, India is a case in point. During 2020–21, general and health insurance companies have covered 514.7 million individuals under 23.7 million health insurance policies (66.6 percent of the individuals under government-sponsored health insurance schemes, 23.1 percent under group policies, and the remaining 10.3 percent under individual policies issued by general and health insurers). Out of the 21 private sector insurers and 7 stand-alone health insurers established in India, foreign investors participate in 16, with foreign equity participation ranging between 23 percent and 49 percent.a
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Share of health expenditure (%)
Figure B1.1.1 Private health insurance schemes (sum of compulsory and voluntary) as a share of total health expenditure in selected countries, 2019
Source: World Health Organization (WHO) Global Health Expenditure Database. Note: As quantified in the WHO Global Health Expenditure Database (GHED), health care spending is primarily financed through the following schemes: (a) government schemes and compulsory contributory health care financing schemes (including compulsory private insurance schemes [CPIS]); (b) voluntary health care payment schemes (including voluntary health insurance schemes [VHIS]); and (c) household out-of-pocket payments. The chart shows the sum of CPIS and VHIS as a percentage of total health care spending. (For more about the GHED methodology, see WHO 2021b.) a. Forty-nine percent was the maximum allowable level of foreign equity until May 19, 2021, when the foreign investment limit in the insurance sector, to also benefit health insurers, was raised to 74 percent by the Insurance Amendment Act, 2021 (IRDAI 2021).
Mode-specific drivers of trade in medical services As defined by GATS, international trade in medical services can take place through four modes of supply (summarized earlier in table 1.2): cross-border supply, consumption abroad, commercial presence, and the movement of individuals across borders.
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